Often patients’ suicidal threats, expressed to family members or other persons, may promote powerful secondary gain that feeds into the suicidal symptomatology. The therapist may have to meet with the entire family to explain the treatment arrangements and to explicitly liberate them from responsibility for the patient’s survival. It needs to be stressed that should the therapist be concerned about the patient’s reliability as protector of his or her own survival between the sessions, it is preferable to hospitalize the patient until a definite diagnosis is achieved and the patient’s capacity for responsible participation in the treatment is reliably assessed.